Pertussis requiring intensive care

Area of Science:

• Pediatric Infectious Diseases
• Critical Care Medicine
• Epidemiology

Background:

• Pertussis (whooping cough) remains a significant cause of severe respiratory illness in infants.
• Intensive care unit (PICU) admissions for pertussis highlight the severity of the disease in young children.
• Understanding risk factors for poor outcomes is crucial for managing pediatric pertussis.

Purpose of the Study:

• To characterize children admitted to the pediatric intensive care unit (PICU) for pertussis.
• To identify clinical factors associated with increased risk of death or disability in these children.
• To evaluate the impact of discharge timing on patient outcomes.

Main Methods:

• Retrospective audit of pertussis admissions to the national PICU in Auckland, New Zealand.
• Data collected from 1991 to 2003, including patient demographics, clinical presentation, interventions, and outcomes.
• Statistical analysis to identify risk factors for adverse outcomes, including death, disability, and readmission.

Main Results:

• 72 infants (<12 months) admitted to PICU with pertussis; annual admissions increased over time.
• Apnoea or paroxysmal cough (83%) and short cough duration (<8 days) were common presenting symptoms.
• 49% required assisted ventilation; 4% died, and 19% were readmitted to PICU.
• Risk factors for death/disability included co-morbidity, elevated lymphocytes, seizures/encephalopathy, shock, high PIM score, abnormal neurological signs, and PICU readmission.

Conclusions:

• Apnoea and paroxysmal cough are critical indicators in infants with short-duration pertussis cough.
• Death or disability is frequent among infants requiring PICU admission for pertussis.
• Clinical factors can identify high-risk children, and early PICU discharge is linked to increased readmission and adverse outcomes.